Surgical clips and clamps

ABSTRACT

A surgical clamp includes a shaft having clamping jaws at a proximal end and an operative handle assembly at a distal end. The shaft has properties for being moved to a desired shape by the user prior to operation of the handle assembly and for holding the desired shape during operation of the handle assembly. The shaft may include a bendable element extending along an axis between the handle assembly and the jaws. A control element disposed relative to the bendable element is operable from the handle assembly at the proximal end of the shaft to move the jaws relative to each other at the distal end of the shaft. An associated method includes the step of bending the shaft to a desired shape prior to operation of the clamp and maintaining the shaft in substantially the desired shape during operation of the clamp.

This application is a 371 of PCT/US98/04702 filed on Mar. 10, 1997 whichclaims benefit of provisional application No. 60/040,655, filed Mar. 10,1997.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to clamps and more specifically toclips, clamps, and devices for operating same in a surgical environment.

2. Discussion of the Prior Art

Clamps have long been used to dilate and occlude body conduits, such asvessels, by pinching the conduit between opposing jaws. Insertsproviding soft and tactile surfaces on the jaws have also beencontemplated. In addition, coil springs have been used to maintain aclosing force on the opposing jaws. Some clamps have been provided withan elongate configuration usually in the form of a shaft extendingbetween the jaws and a handle which operates the jaws through the shaft.The shaft has typically been formed as a rigid, typically-straightassembly, which merely allows the user to reach deeply into a surgicalcavity while operating the jaws exteriorly of the cavity. In some caseswhere the reach is desirable, the shafts of the elongate clamps havebeen provided with a floppy configuration facilitating use of the clampsalong a circuitous path. These floppy shafts have permitted the jaws tobe placed, but have isolated the jaws from incidental movement of thehandle assembly. However, they have not been capable of holding a shapedconfiguration.

Neither the rigid, nor floppy structures of the prior art have addressedthe need for an elongate clamp having a shaft that is semi-rigid, thatis bendable to a desired shape prior to placement of the clamp and yetcapable of maintaining that desired shape during placement and operationof the clamp. These semi-rigid characteristics are particularlydesirable for reaching an object along a circuitous path. A fixed,curved shaft is not adjustable, and a floppy shaft is not capable ofmaintaining a bend during placement and operation of the clamp.

In some situations it is desirable to have a greater degree of controlover the closing force in order to avoid trauma to the conduit. Greatercontrol over other aspects of the placement, operation, maintenance, andremoval of the clips and clamps is always of interest.

SUMMARY OF THE INVENTION

Various embodiments of clips and clamps are included within the scope ofthe present invention. These embodimentg not only include the operativemembers, including opposing jaws, but also various handles, ratchetsystems, quick disconnect apparatus, and remote controls, which greatlyfacilitate control and operation of these systems. It will be clear thatmany of these system elements will be interchangeable with otherelements in order to achieve a desired configuration and control.

At least one of the embodiments of the invention has an elongateconfiguration resulting primarily from a shaft which extends between thejaws of the clamp at a distal end of the shaft and a handle assembly atthe proximal end of the shaft. The shaft in this case has a semi-rigidconfiguration so that it is initially bendable and yet capable ofmaintaining a bend during placement and operation of the clamp. The haftof the clamp may be corrugated or may be formed as a series ofball-and-socket elements. However, in most cases, the shaft will includea stationary element fixed between the housing and the jaws and amovable element movable by operation of the handle assembly to operatethe jaws. Either of the fixed or movable elements may have theconfiguration of a tube in which case the other element is typicallydisposed within the tube.

The stationary element will typically be formed of a material that ismalleable or otherwise semi-rigid. This permits the shaft and the clampto be bent into a desired shape and yet to have sufficient rigidity tomaintain that desired shape during placement of the clamp. In accordancewith one aspect of the invention, the shaft has properties for beingbent into a desired shape by the user prior to operation of the handleassembly and for holding the desired shape during operation of thehandle assembly.

In another aspect of the invention, the shaft comprises a bendableelement extending along a first axis between the handle assembly and thejaws. A control element extends relative to the bendable element along asecond axis, the control element being operable from the handle assemblyat the proximal end of the shaft to move the jaws relative to each otherat the distal end of the shaft.

In a further aspect of the invention, operation of the clamp includesthe step of bending the shaft to a desired shape prior to the surgicaloperation and maintaining the shaft in substantially the desired shapeduring the surgical operation. These and other features and advantagesof the invention will be more apparent from a description of preferredembodiments in reference to the associated drawings.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of a clamp system including a T-handle assemblyfor remotely operating a parallel jaw clamp through a flexible cable inone embodiment of the invention;

FIG. 2 is a side elevation view of a scissors clamp remotely operable bya scissors handle assembly;

FIG. 3 is a further embodiment of a clamp system including a handleassemble with a 2-pawl mechanism;

FIG. 4 is a side elevation view of a clamp system including a clamphaving rounded jaws and an actuation handle providing for variations inforce and speed of closure;

FIG. 5 is a side elevation view of a further embodiment including ahandle assembly and shaft detachable from a clamp;

FIG. 5A is a rear elevation view of the clamp illustrated in FIG. 5;

FIG. 6 is a side elevation view of a clamp interchangeable with theforegoing handle assemblies;

FIG. 7 is a side elevation view of a further clamp operable with thehandle assemblies noted above;

FIG. 8 is a side elevation view of a clamp having an overcentermechanism;

FIG. 9 is a side elevation view of a clamp having an integral ratchetpawl;

FIG. 9A is an axial cross-section view of the clamp illustrated in FIG.9;

FIG. 10 is a side elevation view of a clip having a rounded spring andoperable by a lever mechanism;

FIG. 11 is a flrther embodiment of spring clip of the present invention;

FIG. 12 is a side elevation view of a further embodiment of a clip witha straight spring;

FIG. 13 is a top plan view of a clip having two hinges and opposing jawsin Uconfiguration;

FIG. 13A is a side elevation view of the clip illustration in FIG. 13;

FIG. 14 is a top plan view of a clip with opposing jaws in a L-shapedconfiguration;

FIG. 14A is a side elevation view of the clip illustrated in FIG. 14;

FIG. 15 is a top plan view of an additional embodiment of a clip withaL-shaped configuration;

FIG. 15A is a side elevation view of the clip illustrated in FIG. 15;

FIG. 16 is a top plan view of a clip with a C-shaped configuration;

FIG. 16A is a side elevation view of the clip illustrated in FIG. 16;

FIG. 17 is a side elevation view of the clamp system illustrated in FIG.4 partially in cross-section to illustrate the ghapability of a cableassembly disposed between the clamp and the handle assembly;

FIG. 18 is a perspective view partially in axial cross-section of anembodiment wherein the inner element is movable relative to an outerjacket;

FIG. 19 is a perspective view partially in axial cross-section of anembodiment wherein the inner element is movable relative to the outerjacket;

FIG. 20 is a perspective view partially in axial cross-section of anembodiment wherein the outer jacket is movable relative to the innerelement;

FIGS. 20-22 show various steps in a method for shaping the cable of theclamp;

FIG. 20 is a perspective view showing the cable in a straightconfiguration;

FIG. 21 is a perspective view illustrating the cable being shaped to apredetermined configuration;

FIG. 22 is a perspective illustrating the properties of the cable whichpermit it to maintain the predetermined configuration while reachinginto an operative site;

FIG. 23 is a perspective view illustrating the outerjacket of the cableprovided in the form of a corrugated tube; and

FIG. 24 is a perspective view illustrating the outer jacket of the cableprovided in the form of a series of ball-and-socket joints.

DESCRIPTION OF PREFERRED EMBODIMENTS

A clamp assembly is illustrated in FIG. 1 and designated generally bythe reference numeral 10. Included in the assembly are a clamp 12 andahandle 14 connected by a shaft 16. In this embodiment, the clamp 12 hasa pair of opposing parallel jaws 18 and 21 with a straightconfiguration. The cable 16 includes an outer jacket 23 and an innercable 25 that are moveable relative to each other. The jacket 23 isattached to one of the jaws, such as the jaw 18 while the cable 25 isattached to the other jaw, such as the jaw 21. Thus, movement of thecable 25 relative to the jacket 23 causes the jaws 18 and 21 to moverelative to each other.

The handle 14 in this embodiment includes a T-handle 27 that is adaptedto rest in the palm of the user, and a T-bar 29 that is moveablerelative to the T-handle 27. The T-handle 27 can be fixed to the jacket23 while the T-bar 29 is fixed to the cable 25. Thus, operation of theT-bar 29 relative to the T-handle 27 moves the cable 25 relative to thejacket 23 and also moves the jaw I1 relative to the jaw 18.

Of particular interest in this embodiment is the remote location of thehandle 14 relative to the clamp 12. Also, the cable 25 and associatedjacket 23 can be flexible permitting movement of the handle 14 evenafter the clamp 12 has been operatively fixed in position.

Quick disconnects can be provided at opposite ends of the cable 16 and aratchet mechanism can be provided in the handle 14 in order to maintaina predetermined space and pressure between the jaws 18 and 21. A locklever 30 can be provided on the handle 14 to engage and release theratchet mechanism.

A further embodiment of the clamp assembly is illustrated in FIG. 2. Inthis embodiment structural elements which are similar to thosepreviously discussed will be designated by the same reference numeralfollowed by the lower case letter “a.” Thus the clamping assembly 10 aincludes a clamp 12 a, a handle 14 a and a shaft 16 a. In this case, theclamp 12 a includes opposing jaws 18 a and 21 a, but these jaws areformed in a scissors configuration with opposing levers 32 and 34disposed on opposite sides of a fulcrum 36. The shaft 16 a can be eitherrigid or flexible as in the embodiment of FIG. 1. The handle 14 a canalso be provided with a scissors configuration with opposing palm andfinger grips 38 and 41, respectively, and associated jaws 43 and 45.

The jaws 43 and 45 are connected to an associated one of the cable andjacket of the shaft 16 a. In this manner, movement of the grips 48 and41 produces relative movement between the cable and jacket of the shaft16 a as well as the jaws 18 a and 21 a of the clamp 12 a. It will benoted that the jaws 43 and 45 of the handle 14a can be a formed integralwith different ones of the grips 38 and 41 so that closure of thesegrips can alternatively result in either opening or closing the jaws 18a and 21 a.

A further embodiment of the invention is illustrated in FIG. 3 whereelements of similar structure are designated by the same referencenumeral followed by the lower case letter “b.” In this embodiment, theshaft 16 of previous embodiments is formed as two shafts 47 and 51 thatare axially moveable relative to each other. The jaws 18 b and 21 b areattached to associated ones of these shafts 47 and 51. The handle 14 bin this embodiment also includes a ratchet mechanism including a ratchetgear 52 attached to the shaft 47, and a pair of pawls 54 and 56 whichare independently pivotal on the shaft 51 to engage the ratchet gear 52.

A further embodiment of the invention is illustrated in FIG. 4 whereelements of similar structure are designated by the same referencednumeral followed by the lower case letter “d.” The shaft 16 d of thisembodiment is similar to that illustrated in FIG. 1 as it includes ajacket 23 d and coaxial cable 25 d. In this embodiment, the jaws 18 dand 21 d of the clamp 12 d are parallel but provided with a curvedrather than a straight configuration. Also, inserts are illustrated forthese jaws 18 d and 21 d. These inserts can be provided with a“sawtooth” pattern to facilitate atraumatic gripping of a vessel.

The handle 14 d of this embodiment is of particular interest. Itincludes opposing grip portions 27 d and 29 d that are molded with aliving hinge 53 therebetween. This hinge 53 d forms a fulcrum for thislever system. The cable 25 d is attached near the hinge 53 preferably tothe grip 29 d.

The finger grip 29 d is provided with a camming surface 55 which ridesagainst the cable 25 d. As the grips 27 d and 29 d are moved intoproximity, the cable 25 d is forced against the camming surface 55 andthereby moved relative to the jacket 23 d of the shaft 16 d. The cammingsurface 55 can be provided with a circular configuration, as in theillustrated environment, or with any other configuration to facilitatevariations in speed, distance and force applied to the cable 25 d.

A ratchet mechanism can also be provided in this embodiment. In thiscase, a ratchet gear 54 and pawl 56 can be formed on engaging surfacesof the grip members 29 d and 27 d, Grespectively. It will be noted thatin this embodiment that the camming surface 55 can be formed on a thin,flexible member 57 in order to provide some “give” to the cable 29 b asthe gripping members 27 d and 29 d are moved into proximity.

An additional embodiment of the invention is illustrated in FIG. 5wherein elements of similar structure are designated by the samereference numeral followed by the lower case letter “e.” In thisembodiment, the lower jaw 21 e of the clamp 12 e is formed integral witha cylindrical housing 57 which is slotted to receive the upper jaw 18 e.A screw 59 extends through the housing 57 where its thread engages theupper jaw 18 e. As the screw 59 turns, the upper jaw 18 e rides on thethreads of the screw 59 and thereby moves relative to the fixed jaw 29 eand housing 57.

The screw 59 is provided with a stub 61 at its proximal end, the stub 61having in radial cross-section a shape which is non-circular, such assquare. This stub 61 is adapted for removable engagement by anassociated handle 14 e and shaft 16e mechanism. In this case, the shaft16 e includes a rigid jacket 23 e and an associated rigid coaxial shaft63. Operation of the handle 14 e in this embodiment results in rotatingthe inner shaft 63 relative to the jacket 23 e. A recess 65 at thedistal end of the shaft 63 e can be shaped complimentary to the stub 61of the clamp 12 e to provide a mating engagement between these elements.Then, as the handle 14 e is operated, the shaft 63 turns along with thestub 61, and the jaws 18 e and 21 e move relative to each other, Theease with which the clamp 12 e and shaft 16 e can be engaged anddisengaged is a significant feature of this embodiment.

An alternative clamp is illustrated in the embodiment of FIG. 6 whereelements of similar structure are designated by the same referencenumeral followed by the lower case letter “f.” In this embodiment a pawlmechanism 67 is provided on the clip 12 f. This mechanism 67 includes aratchet gear 69 formed on the jaw 18 f, and a pawl formed on the housing57 f associated with the lower jaw 21 f. As the jaw 18 f moves relativeto the jaw 21 f, the ratchet gear 69 moves relative to the pawl 71 witha racketing action well known in the art. A pin 73 can be provided onthe housing 57 f to release the pawl 71 from engagement with a ratchetgear 69. By providing the pawl mechanism 67 on the clamp 12 f, a higherdegree of ratchet control can be provided in proximity to the jaws 18 fand 21 f.

A further clamp mechanism is illustrated in FIG. 7 wherein elements ofsimilar structure are designated by the same reference numeral followedby the lower case letter “g.” In this case, the jaws 18 g and 21 g areprovided with a scissors mechanism 75 which tends to maintain the jaws18 g and 21 g in a parallel orientation. A mechanism 75 has a scissorsconfiguration with opposing elements 77 and 79 pivotal on one of thejaws 18 g and 21 g and slidable in a groove on the other ofthejaws 18 gand 21 g. A pin 82 joins the scissors element 77 and 79 to provide afulcrum. Movement of this pin 82 relative to the housing 57 g causes thejaws 18 g and 21 g to open and close. Of course the clamp 12 g can beoperated in other manners, for example by moving the jaw 18 g, or eitherof the scissors elements 77 and 79 relative to the housing 57 g.

In the embodiment of FIG. 8, elements similar to those previouslydescribed are designated by the same reference numeral followed by thelower case letter “h.” In this embodiment, thejaws 18 h and 21 h may notmove parallel to each other. These jaws 18 h and 21 h are joined at apivot pin 84 and are also joined by an overcenter mechanism designatedby the reference numeral 86. This mechanism 86 includes a leg 88 pivotalon the jaw 18 h and a leg 90 pivotal on the jaw 21 h. These legs 88 and90 are joined by a fulcrum pin 92 to form an overcenter mechanism whichfacilitates releasable locking engagement of the jaws 18 h and 21 h.Actuation of this clamp 12 h can be accomplished by engaging the fulcrumpin 92 and moving it relative to the jaw 21 h to open and close the jaw18 h.

Elements similar to those previously described are designated by thesame reference numeral followed by the lower case letter “i”, in afurther embodiment illustrated in FIG. 9. In this embodiment, the clamp12 i includes an upper jaw 18 i which is integral with the housing 57 i.The lower jaw 21 i extends through this housing 57 i for operation bythe shaft 92 and housing assemblies. The ratchet gear 91 is formed onthis shaft 92 while a ratchet pawl 94 is molded into the housing 57 i .A ratchet release 96 can be slidable along the shaft 92 to separate thepawl 94 from the ratchet gear 91.

FIGS. 10-12 relate to clip designs that are particularly adapted foroccluding vessels. Each of these clips includes a pair of opposingjaws101 and 103. A wire form hinge 105 is connected to these jaws 101 and103 and biases them to a closed, occluding relationship. In theembodiment of FIGS. 10 and 11, the wire hinge 105 is bent back on itselfto form opposing legs which are disposed to extend along the jaws 101and 103, respectively. In the embodiment of FIG. 10, a closed end 111 ofthe hinge 105 is positioned intermediate the ends of the respective jaws101 and 103. In this embodiment, the closed end 111 functions as afulcrum. A force applied to that portion ofthe jaws 107 and 109 whichextend beyond the end 111 opens the jaws 101, 103 of the clip.

This operation can be compared with the clip disclosed in FIG. 11 wherethe closed end 111 of the wire hinge 105 extends beyond the length ofthe jaws 101 and 103. Although the hinge 105 provides the same bias forthe jaws 101, 103 as in the embodiment of FIG. 10, actuation of thisstructure requires an opposing force against the arms 107, 109 of thehinge I 05 or the jaws 101, 103 in order to open the clip.

A further embodiment of the clip is illustrated FIG. 12 where the wirehinge 105 has a straight configuration. This hinge of 105 could beprovided either by a metal wire or a flat wire spring. In this case thehinge 105 extends generally perpendicular to the jaws 101 and 103.Nevertheless, it provides the same bias action to close the clip as inthe embodiments of FIGS. 10 and 11. The placement of this hinge 105 inFIG. 12 will of course be between the ends of the respective jaws 101and 103 so that the clip can be operated in the manner discussed withreference to FIG. 10.

Other embodiments of the clip of the present invention are illustratedin FIGS. 13-16 and the associated side views of FIGS. 13a-16 a. In eachof these embodiments, at least one wire hinge 105 is provided as in theforegoing embodiments. However, as opposed to the straight parallel jawsof FIGS. 10-12, the opposing jaws 103 and 105 in these embodiments areprovided with other than a straight shape. Thus in the embodiment ofFIGS. 13 and 13a, the jaws 101 and 103 have a U-shaped configuration.The wire hinge 105 extends throughout the length of these jaws 101 and103 and forms two hinges 107 and 109 at these opposing ends.

The embodiment of FIGS. 14 in 14 a includes jaws 101 and 103 which havean L-shaped configuration with the hinge 107 of the wire 105 formed atthe end of the short leg of the jaws 101, 103. As illustrated in FIG.14a, the free end of the L-shaped legs can be provided with an extensionor “toe-in” 113 to compensate for spring action.

The embodiment of FIGS. 15 and 15a also have an L-shaped configuration.However, in this embodiment, the hinge 107 is formed at the end of thelong leg of the “L”.

In a further embodiment illustrated in FIG. 16 and 16a, the jaws 101 and103 have a C-shaped configuration. In this embodiment, only one hinge107 is illustrated although two hinges 107, 109 can be provided as inthe embodiment of FIG. 13.

FIG. 17 is a perspective view similar to that of FIG. 4. In this view,elements of structure similar to those previously disclosed will bedesignated with the same reference numeral followed by the lower-caseletter j. Thus, the embodiment of FIGS. 4 and 17 includes the flexiblecable assembly 16 j, which is similar to the assembly 16 d in that it isboth flexible and shapable. In effect, the cable assembly 16 j issemi-rigid so that it is not merely floppy and incapable of holding ashape, but rather bendable to a desired configuration. Once the assembly16 j has been bent to a predetermined shape, it is capable ofmaintaining that shape so that the clamp assembly 10 is adapted to reachinto difficult locations to engage, grasp, and perhaps occlude an objectsuch as a blood vessel 121. As previously noted, the cable 1 6j has adistal end 123 adapted to receive the clamp 12 j, and a proximal end 125adapted to receive the handle.

In the manner previously discussed, the cable 16 j will typicallyinclude the jacket 23 j and a co-axial cable or element 25 j. One of thejacket 23 j and the element 25 j is fixed while the other of the jacket23 j and the element 25 j is movable and attached to the other jaw 18 jand 21 j. For example, in the embodiments of FIGS. 4 and 17, the jacket23 j is fixed and attached to the jaw 21 j while the element 25 j ismovable relative to the jacket 23 j and attached to the jaw 18 j. Inthis case, the jaws 18 j and 21 j are biased to an open position by acompression spring 127. As the handle 14; is operated, the element 25 jis pulled proximally relative to the jacket 23i thereby opposing thebias of the compression spring 127 and moving the jaw 18 j into aclosing relationship with the jaw 21 j.

This embodiment of FIGS. 4 and 17 is only one of several embodimentswherein the cable 16 j is flexible so that it has properties for beingadjusted to a predetermined shape and for maintaining that shape untilfurther adjusted. These characteristics of the cable 16 j are ofparticular advantage when it is desirable to engage or occlude anobject, such as the blood vessel 121, that is not accessible in astraight line. By adjusting or bending the cable 16 j , the clamp 12 jcan be moved around organs and otherwise directed along a circuitouspath to engage the vessel 121. The clamp 12 j can then be operated atthe distal end 123 of the cable 16 j by manipulating the handle 14j atthe proximal end 125. These flexible characteristics are also referredto herein as semi-rigid properties. The cable 16 j is preferablysufficiently soft that it can be shaped to a predetermined curvedconfiguration, but also sufficiently rigid that it can maintain thepredetermined configuration until it is re-shaped.

These properties of the cable 16 j can be achieved by providing eitherthe jacket 23 j or the inner element 25 j with the shapablecharacteristics. For example in FIG. 21, the clamp 12j is operable bymoving the inner element 25 j relative to the fixed outer jacket 23 j .In the embodiment of FIG. 22, the outer jacket 23 j is movable relativeto the fixed inner element 25 j .

Typically, but not necessarily, it is the stationary or fixed one of thejacket 23 j and inner element 25 j, that is provided with the shapablecharacteristics. The other of the jacket 23 j and inner element 25 jwill typically not be shapable.

In operation, the movable element, such as the element 25 j, follows thepredetermined curve of the shapable element, such as the outer jacket 23j in FIG. 21. The movable element, such as the inner element 25 j, willusually have tension characteristics to oppose the bias of the spring127 and to move the clamp 12 j into a closed state. In some embodiments,the jaws of the clamp 12 j will not be biased in which case the movableelement will typically have both tension and compression characteristicsto move the jaws 18 j and 21 j into an closed position or open position,respectively.

The semi-rigid cable 16 j will typically be provided in a straightconfiguration such as that illustrated in FIG. 20. The user will thenbend the cable 16 j to a predetermined shape using both hands 127, 130.The predetermined shape may include an S-curve as 132, as illustrated inFIG. 19. Importantly, the semi-rigid properties of the cable 16 j enableit to maintain this predetermined shape, such as the S-curve 132 untilit is re-shaped, typically by using both hands 127, 130. With thesecharacteristics, the shapable clamp assembly 10 j can be used to reachalong a circuitous path in order to engage the blood vessel 121 at anoperative site such as that designated by the referenced numeral 134 inFIG. 20.

The shapable characteristics of either the outer jacket 23 j (in thecase of the FIG. 22 embodiment) or the inner element 25 j (in the caseof the FIG. 21 embodiment) can result from several different structuralconfigurations. For example, the fixed element, such as the outer jacket23 j, can be formed from a metal which is bendable or malleable toachieve the desired shape. The semi-rigid characteristics can also befacilitated by forming the outer jacket 23 j in the shape of acorrugated tube 134 illustrated in FIG. 23. The semi-rigid, shapablecharacteristics can also be achieved by providing the outer jacket 23 jin the form of a series of ball-and-socket joints 136 as illustrated inFIG. 24.

With reference to all of the foregoing embodiments, it will be apparentthat many variations can be achieved by combining any of the clips orclamps with any of the handles or remote cable assemblies. In addition,the placement of ratchet assemblies can be varied. For example theratchet assembly can be provided in the handle assembly as illustratedin FIG. 3, or in the clamp assembly as illustrated in FIGS. 6 and 9.Cable assemblies providing for remote operation can be either rigid asillustrated in the embodiment of FIG. 3 or flexible as illustrated inthe embodiment of FIG. 4. Handle assemblies can also vary widely asillustrated in the different embodiments of FIGS. 1, 2, 4, and 5. All ofthe foregoing embodiments and variations thereof are believed to bewithin the concept of the present invention.

What is claimed is:
 1. A surgical clamp, comprising: a semi-rigid shaftextending between a proximal end and a distal end; a pair of clampingjaws disposed at the distal end of the semi-rigid shaft and movablerelative to each other to clamp an object between the jaws; a handleassembly disposed at the proximal end of the semi-rigid shaft, thehandle assembly being operable at the proximal end of the semi-rigidshaft to move the jaws relative to each other at the distal end of thesemi-rigid shaft to clamp the object; and the semi-rigid shaft beingsufficiently flexible to be movable from a first shape into a desired,second shape, and being sufficiently rigid for maintaining the desired,second shape during operation of the handle assembly.
 2. The surgicalclamp recited in claim 1 wherein the shaft is malleable.
 3. The surgicalclamp recited in claim 1, further comprising: a control elementextending relative to the shaft and moveable by the handle assembly atthe proximal end of the shaft to operate the jaws at the distal end ofthe shaft.
 4. The surgical clamp recited in claim 3, wherein: the shaftcomprises a tube having a lumen; and the control element is disposedrelative to the lumen of the tube.
 5. The surgical clamp recited inclaim 4, wherein the control element has properties for being placed intension to operate the jaws.
 6. The surgical clamp recited in claim 5,wherein the control element has properties for being placed incompression to operate the jaws.
 7. The surgical clamp recited in claim5, wherein the control element includes a wire.
 8. The surgical clamprecited in claim 6, wherein the tube of the shaft is a first tube andthe control element comprises a second tube disposed relative to thiefirst tube.
 9. The surgical clamp recited in claim 8, wherein the secondtube is disposed interiorly of the first tube.
 10. The surgical clamprecited in claim 8, wherein the second tube is disposed exteriorly ofthe first tube.
 11. The surgical clamp recited in claim 5, wherein thejaws are movable between a first position and a second position and thesurgical clamp further comprises: a spring coupled to at least one ofthe jaws for biasing the jaws to the first position.
 12. The surgicalclamp recited in claim 11, wherein the first position is a closedposition.
 13. A surgical clamp, comprising: a shaft extending between aproximal end and a distal end; a pair of clamping jaws disposed at thedistal end of the shaft and movable relative to each other to clamp anobject between the jaws; a handle assembly disposed at the proximal endof the shaft, the handle assembly being operable at the proximal end ofthe shaft to move the jaws relative to each other at the distal end ofthe shaft to clamp the object; and the shaft comprising a semi-rigidbendable element extending along a first axis between the handleassembly and the jaws, the semi-rigid bendable element beingsufficiently flexible to be movable from a first shape into a desired,second shape, and being sufficiently rigid for maintaining the desired,second shape during operation of the handle assembly; and a controlelement extending relative to the bendable element along a second axis,the control element being operable from the handle assembly at theproximal end of the shaft to move the jaws relative to each other at thedistal end of the shaft.
 14. The surgical clamp recited in claim 13,Awherein the first axis of the bendable element is co-axial with thesecond axis of the control element.
 15. The surgical clamp recited inclaim 14, wherein: the bendable element includes a tube; and the controlelement is disposed within the tube of the bendable element.
 16. Thesurgical clamp recited in claim 14, wherein: the control elementincludes a tube; and the bendable element is disposed within the tube ofthe control element.
 17. The surgical clamp recited in claim 13, whereinthe semi-rigid element is malleable.
 18. The surgical clamp recited inclaim 13, wherein the semi-rigid element is corrugated.
 19. The surgicalclamp recited in claim 13, wherein the semi-rigid element includes aseries of ball-and-socket joints.
 20. A method for operating a surgicalclamp, comprising the steps of: providing a shaft having a proximal endand a distal end with a pair of clamping jaws at the distal end andmovable to clamp an object during a surgical operation, and a handleassembly disposed at the proximal end to operate the jaws at the distalend during the surgical operation; bending the shaft to a desired shapeprior to operation of the clamp; and maintaining the shaft insubstantially the desired shape without external force during operationof the clamp.
 21. The method recited in claim 20, wherein the providingstep includes the step of providing the shaft with a corrugatedconfiguration.
 22. The method recited in claim 20, wherein the providingstep includes the step of providing the shaft in the form of a series ofball-and-socketjoints.